NEUROSURGERY

Craniotomy

Removing part of the cranium in a procedure called a craniotomy is necessary for certain brain surgeries. The skull covers the brain. One of the major ways to reach the brain is through the skull. A craniotomy ranges in size. Sometimes the cut is small and other times it is fairly large. The size is primarily dependent upon the problem being fixed. A craniotomy can be done on any part of the skull. It is not just used for one type of problem, but it can treat many. There are many aspects of a craniotomy. Understanding the ins and outs of the procedure will help you prepare for it if it is something a physician has suggested.

The brain has different parts which are responsible for specific things. There is a host of diseases the brain is susceptible to. Some common issues in the brain include tumors, blood clots, and skull fractures. An injury is a source for many of these things. Bullets, infection, and swelling are also common. During accidents, people may experience head trauma which leads to concussions. Severe concussions may cause bruising and swelling. Fluid is likely to build in the brain as well. Whenever these situations occur, a craniotomy may be necessary.

Cause

A craniotomy is done wherever the injury has occurred. It can be between two bones or just in one bone. There are five total bones in the cranium: frontal bone, two temporal bones, parietal bone, occipital bone. There is not just one type of craniotomy. They are all dependent upon which part of the brain the incision is made. When incisions are made between two bones, the name is a combination of both bones. For example, a cut made between the frontal and temporal bones are called frontotemporal craniotomies. Craniotomies are also named based on its location in the bone. Cuts low in the bone have the prefix sub. Sub means below or underneath. Suboccipital craniotomies are incisions made in the bottom part of the occipital bone.

There are several ways to do a craniotomy. The first step in most cases is to have a scan of the brain. The doctor has to see not only what the problem is, but also where the problem is occurring. Most of the time the doctor uses an MRI or CT scans. The scan shows bruising, fractures, and other forms of trauma. Without the scan, the doctor will not know how bad the situation is or where the problem is located. The scans also show how deep the damage goes into the tissue. The next step is fixing the problem.

The skull is very thick. You cannot cut into it with just a scalpel. It requires the use of strong tools. No matter what the procedure is, the doctor will typically shave and sterilize the part of the cranium where the craniotomy will begin. A doctor should never perform any procedure without sterilization. Since the procedure is in the head, they may have to cut your hair off in that area. As devastating as that sounds for some people, it will grow back. Some craniotomies only require the use of a needle. In cases where tissue or pieces of a tumor require biopsy, a needle is put into the area of the tissue. The tissue is removed. When there is too much fluid in the brain, a needle may also be placed into the brain to drain the excess fluid. In more severe cases, a piece of the skull is removed. In most cases, it only creates a flap rather than a full hole. This more invasive procedure is done when there is a lot of swelling on the brain. Removing part of the skull gives the brain room to breathe without causing more bruising or damage. Aneurysms are another problem that requires the complete opening of the skull. In most brain aneurysms, the only treatment available is clipping the aneurysm to stop the bleeding. To clip an aneurysm, the doctor has to get to the blood vessel. Sometimes aneurysms are just large and upon examination, the doctor may feel the need to repair it before it burst.

When it comes to craniotomies, there is not just one type. The procedure used is completely dependent upon the condition. If you have a tumor in the occipital lobe, the cut will be made in that bone. It would be crazy for the doctor to make the cut anywhere else. No one desires to undergo brain surgery. The thought of it can be intimidating and very scary. Now, there are minimally invasive options. Before, no matter what the problem was, the incision made in the skull was large enough for the doctor to insert their hands and tools to fix it. Today, some problems can be fixed with tiny incisions and the use of microscopic tools. Minimally invasive craniotomies allow for much faster procedures and quicker recovery times. Craniotomies are serious, but it can be life-saving.

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